Improving Outcomes in PSVT: Best Practices for Choosing Optimal Management Strategies

Ambulatory Monitoring Approaches for PSVT: Which One and When?

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Jennifer Carlquist, PA-C:
Welcome to this educational activity from GLC. I'm Jen Carlquist, and here with me today is Brian Rose. We're taking a deep dive into ambulatory monitoring approaches for PSVT, or paroxysmal supraventricular tachycardia.

Brian, there's a lot of options out there for monitoring; I'd love to know the pros and cons of each and how you feel about them.

Brian Rose, PA-C:
Absolutely. That is definitely a loaded question. There are quite a few, both wearable and non-wearable, options out there, and I feel like every day we're being inundated with another device to really be able to pinpoint rhythm issues.

A lot of what we select is very patient-centric, and what I mean by that is the frequency of their symptoms. If we have a patient that has daily symptoms, a simple Holter monitor is perfect for them for 24 hours or 48 hours. Patients that may have less frequent symptoms but we're very suspicious for an underlying rhythm issue, an event monitor for up to 28 days is very applicable in that situation. Smartwatches have really gained a lot of traction as of late, and I can say anecdotally that I have diagnosed a few rhythm issues based off smartwatches. Other devices that exist that patients can utilize at home are like the KardiaMobile device, and in some instances where we're really suspicious, in instances where maybe the Holter monitors and the event monitors have been unrevealing or inconclusive but we still have a high index of suspicion, an implantable loop recorder is definitely applicable.

Jennifer Carlquist, PA-C:
Totally agree 100%, Brian. And I have also had the events where I've diagnosed patients based on reading some of their smartwatches. And what I would like to share with practitioners who are watching is that get familiar and comfortable with how to look up in their health app where these strips are, because there is so much data there. We had a patient who came to the ER with palpitations, and nothing was ever caught on the monitor. And before he was going to go home, he said, "Oh, by the way, I have a watch. I think I had the episode when I had the watch on." And we pulled up the episode, and we diagnosed him right there, and he was all of a sudden no longer being discharged, and he was going to be getting appropriate follow-up.

So I will say that it is very important, when you're doing a wearable and you're using that as your decision-maker, that the patient has to be still, and that's true for the Kardia, and that's very true for the Apple Watch; they need to be still and have good contact to the device to give us the good data.

Brian, how do you feel about wearables for patients with PSVT?

Brian Rose, PA-C:
I think wearables are definitely kind of the cornerstone. Very few patients will present to the ER with an active PSVT. I feel like a lot of the patients that we see are these, quote, palpitation consults, which could be anything. These could be patients that have AFib. These are patients that can have PSVT. They can be having non-sustained VT from their heart failure or their coronary artery disease.

So the wearables are just another way that we're able to really distill down what we're dealing with because it's so critical that we get the diagnosis right here. I think a lot of what we've heard quite frequently in our discussions that a lot of these patients, especially with PSVT, get passed around. They get told that they have anxiety or there's nothing wrong with them.

So utilizing the wearables appropriately and maybe not just resting on the 48-hour Holter and saying, "Well, it didn't show anything,” really, let the frequency of their symptoms guide what sort of diagnostic tools you need to use.

Jennifer Carlquist, PA-C:
And I have to tell you, Brian, that it's just like when you take the car to the mechanic, it stops making the noise. Sometimes that happens when we put on these devices like Holters or event recorders. And that's why sometimes I'll actually end up leaning more towards something a little bit longer because it gives them a little extra time. I feel like the heart almost gets shy when it knows we're looking for that pesky arrhythmia. So it's important to use all the tools that we have at our disposal.

So I hope this gave you something to think about tonight with Brian's excellent pearls and things that you can actually put into practice as soon as tomorrow. And thank you all for your attention and being here.

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Overview
The management of paroxysmal supraventricular tachycardia (PSVT) remains challenging, with diagnostic delays, variability in ambulatory monitoring and triage, and inconsistent implementation of evidence-based treatment strategies contributing to fragmented care. Although catheter ablation is recommended as first-line therapy for many patients experiencing symptoms, real-world management remains variable, and many patients continue to rely on emergency department care for recurrent episodes. In this series, expert faculty review best practices for diagnosing PSVT, differentiating narrow complex tachycardias, and developing individualized management plans. The discussions also examine emerging phase 3 data supporting structured, symptom-prompted, patient-initiated outpatient treatment approaches and consider how these findings may influence future PSVT care.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative requires all faculty and planners to disclose financial relationships with ineligible companies. All relevant financial relationships have been reviewed and mitigated to ensure that the content is free from commercial bias.

The following faculty and planners have disclosed relevant financial relationships with ineligible companies in the past 24 months.

Faculty:
Jennifer Carlquist, PA-C
Physician Assistant
Wellstar Health System
Marietta, GA

Jennifer Carlquist has no relevant relationships to disclose.

Sean Pokorney, MD, MBA
Electrophysiologist
Assistant Professor of Medicine
Director, Arrhythmia Core Laboratory
Duke University
Durham, NC

Consulting Fees: Abbott, Boston Scientific, Medtronic, Milestone Pharmaceuticals, Philips
Speaker: Abbott, Medtronic, Philips, Zoll Medical
Clinical Research: Medtronic, Milestone Pharmaceuticals, Philips

Brian P. Rose, PA-C, MPH, AACC
Assistant Professor, Methodist University PA Program
Department of Cardiology
First Health of the Carolinas
Pinehurst, NC

Consulting and Speaking: Bayer, Mannkind, Milestone, Lexicon
Advisory Board: Esperion, iRhythm

Reviewers/Planners/Authors:
- Cindy Davidson has no relevant relationships to disclose.
- Wilma M. Guerra has no relevant relationships to disclose.
- Brian P. McDonough, MD, FAAFP, has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
- Differentiate paroxysmal supraventricular tachycardia (PSVT) from other narrow complex tachycardias, including atrial fibrillation with rapid ventricular response, using ECG characteristics and clinical presentation
- Select appropriate ambulatory monitoring strategies to confirm PSVT in patients experiencing symptoms
- Apply contemporary guideline recommendations to determine the appropriate site of care and management pathway for patients with PSVT, including timely electrophysiology referral and structured outpatient episode management
- Incorporate shared decision-making principles when discussing ablation, pharmacologic options, and long-term rhythm strategy
Target Audience
This activity has been designed to meet the educational needs of cardiologists and emergency medical professionals as well as all other physicians, physician assistants, nurse practitioners, nurses, pharmacists, and healthcare professionals involved in managing patients with PSVT.
Provider(s)/Educational Partner(s)

Global Learning Collaborative (GLC) designs and executes continuing education rooted in evidence-based medicine, clinical need, knowledge gap analysis, and careful consideration of learner feedback. Our mission is to serve as an inventive and relevant resource for clinical content and educational interventions across a broad spectrum of specialties. GLC’s methodology is founded on a commitment to continuing medical education and the innovative assessment of its effects on clinical practice. Our goal is clear—to develop and deliver the best education in the most impactful manner and to verify its results with progressive outcomes research.
Commercial Support
This activity is supported by an independent educational grant from Milestone Pharmaceuticals, Inc.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information.

Reproduction Prohibited
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Publication Dates
Release Date: 10/01/2026
Expiration Date: 10/01/2027